Retirement Plan Administration Year End Questionnaire 2024 "*" indicates required fields Who is filling out this form?* First Last Your Email Address* Enter Email Confirm Email What is the name of the company for which you are completing this form?* 1) What type of retirement plan(s) do you have? (Select ALL that apply)* Defined Benefit Plan Profit Sharing Only - no 401(k) 401(k) Plan - with or without Profit Sharing Other (403b, 457, etc.) 2-DB) Does the company intend to make a tax deductible employer contribution to the DEFINED BENEFIT plan for the 2024 tax year?* Yes No Unsure If you know a specific contribution dollar amount for the DEFINED BENEFIT plan, enter it here. If you don't have a specific dollar amount in mind, you can enter a range, a maximum amount, or if you leave it blank, the FAL plan administrator assigned to your plan will contact you to discuss. 3) Regarding the DEFINED BENEFIT plan contributions mentioned in question 2, have any been made PRIOR to 12/31/2024? (This is not particularly common).*(This is not the same as contributions made in 2024 for the 2023 plan year and deducted on the 2023 tax return.) Yes No Unsure Please list here the Date(s) and Amount(s) of the deposits made to the DEFINED BENEFIT Plan for 2024, made PRIOR to 12/31/2024:2-PS) Does the company intend to make a tax deductible employer contribution to the PROFIT SHARING plan for the 2024 tax year?* Yes No Unsure If you know a specific contribution dollar amount for the PROFIT SHARING plan, enter it here. If you don't have a specific dollar amount in mind, you can enter a range, a maximum amount, or if you leave it blank, the FAL Plan Administrator assigned to your plan will contact you to discuss. 3) Regarding the PROFIT SHARING plan contributions mentioned in question 2, have any been made PRIOR to 12/31/2024? (This is not particularly common).*(This is not the same as contributions made in 2024 for the 2023 plan year and deducted on the 2023 tax return.) Yes No Unsure Please list here the Date(s) and Amount(s) of the deposits made to the PROFIT SHARING Plan for 2024 made PRIOR to 12/31/2024:2-401K) Does the company intend to make a tax deductible employer contribution to the 401(K) PLAN for the 2024 tax year OTHER THAN the standard 401(k)/Safe Harbor (if applicable) contributions?* Yes No Unsure If you know a specific contribution dollar amount for the 401(K) plan, enter it here. If you don't have a specific dollar amount in mind, you can enter a range, a maximum amount, or if you leave it blank, the FAL Plan Administrator assigned to your plan will contact you to discuss. 3) Regarding the 401(K) plan contributions mentioned in question 2, have any been made for 2024 PRIOR to 12/31/2024? (This is not particularly common).*(This is not the same as contributions made in 2024 for the 2023 plan year and deducted on the 2023 tax return.) Yes No Unsure Please list here the Date(s) and Amount(s) of the deposits made to the 401(K) Plan for 2024 PRIOR to 12/31/2024:2-OTHER) Does the company intend to make an employer contribution to the plan for the 2024 tax year OTHER THAN the standard employee contributions?* Yes No Unsure If you know a specific dollar amount for the OTHER (403(b), 457, etc.) plan, enter it here. If you don't have a specific dollar amount in mind, you can enter a range, a maximum amount, or if you leave it blank, the FAL Plan Administrator assigned to your plan will contact you to discuss. 3) Regarding the OTHER (403(b), 457, etc.) plan contributions mentioned in question 2, have any been made for 2024 PRIOR to 12/31/2024? (This is not particularly common).*(This is not the same as contributions made in 2023 for the 2022 plan year and deducted on the 2022 tax return.) Yes No Unsure Please list here the Date(s) and Amount(s) of the deposits to the Other (403(b), 457, etc.) Plan made for 2024 PRIOR to 12/31/2024:Fiduciary Advisors, Ltd. needs to be aware of ALL assets/investments in the plan as well as ALL transactions, deposits and withdrawals for 2024. Please provide copies of each of your plan's 2024 YEAR-END brokerage statement(s) as soon as possible (this is not necessary for plans on recordkeeping platforms - see question #4)Please note that based on your answers, some questions may be skipped and not appear in numerical order.4-PS) Did the PROFIT SHARING PLAN primarily use an online recordkeeping system where participants can choose from a limited selection of mutual funds pre-determined by the plan trustee (e.g. John Hancock, Principal, American Funds, Ameritas, Voya, Empower, etc...) for all of 2024?*(Profit Sharing-only plans commonly answer 'No') Yes No Unsure Please provide copies of your PROFIT SHARING plan's 2024 YEAR-END brokerage statement(s) as soon as possible.4.a PS) Other than the online recordkeeping system where participants can choose their investments, were there any other assets in the PROFIT SHARING Plan, such as individual brokerage accounts, real estate, collectibles, closely held stock, etc...) at any time during 2024?*(This is uncommon) Yes No Please list these other accounts and assets in the PROFIT SHARING Plan and their value as of 12/31/2024. Any non-traditional assets (real estate, collectibles, closely-held stock, etc...) REQUIRE an annual appraisal, so also include the date of the last independent appraisal.*5) Was 2024 the first year of your PROFIT SHARING retirement plan mentioned above?* Yes No Unsure Please list all accounts and assets in the PROFIT SHARING Plan and their value as of 12/31/2024. Any non-traditional assets (real estate, collectibles, closely-held stock, etc...) REQUIRE an annual appraisal, so also include the date of the last independent appraisal.5.a-PS) Did you use PROFIT SHARING Plan Assets to open any NEW accounts, or purchase other assets, that were NOT part of the retirement plan in 2023?*(We need to know if you have deposited plan assets somewhere else that we may not be aware of). Yes No Unsure Please list any new investments that have been added to the PROFIT SHARING Plan since 1/1/2024:*4-401k) Did the 401(K) PLAN primarily use an online recordkeeping system where participants can choose from a limited selection of mutual funds pre-determined by the plan trustee (e.g. John Hancock, Principal, American Funds, Ameritas, Voya, etc...) for all of 2024?* Yes No Unsure Please provide copies of your 401(k) plan's 2024 YEAR-END brokerage statement(s) as soon as possible.4.a 401K) Other than the online recordkeeping system where participants can choose their investments, were there any other assets in the 401(k) Plan, such as individual brokerage/retirement accounts, real estate, collectibles, closely held stock, etc...) at any time during 2024?*(This is uncommon) Yes No Please list these other accounts and assets in the 401(k) Plan and their value as of 12/31/2024. Any non-traditional assets (real estate, collectibles, closely-held stock, etc...) REQUIRE an annual appraisal, so also include the date of the last independent appraisal.*5) Was 2024 the first year of your 401(K) retirement plan mentioned above?* Yes No Unsure Please list all accounts and assets in the 401(k) Plan and their value as of 12/31/2024. Any non-traditional assets (real estate, collectibles, closely-held stock, etc...) REQUIRE an annual appraisal, so also include the date of the last independent appraisal.5.a 401K) Did you use 401(k) Plan Assets to open any NEW accounts, or purchase other assets, that were NOT part of the retirement plan in 2023?*(We need to know if you have deposited plan assets somewhere else that we may not be aware of). Yes No Unsure Please list any new investments that have been added to the 401(k) Plan since 1/1/2024:*4-OTHER) Did the Other (403(B), 457, etc.) Plan primarily use an online recordkeeping system where participants can choose from a limited selection of mutual funds pre-determined by the plan trustee (e.g. John Hancock, Principal, American Funds, Ameritas, Voya, Empower, etc...) for all of 2024?* Yes No Unsure Please provide copies of your OTHER (403(b), 457, etc.) plan's 2024 YEAR-END brokerage statement(s) as soon as possible.4.a OTHER) Other than the online recordkeeping system where participants can choose their investments, were there any other assets in the OTHER (403(B), 457, etc.) Plan, such as individual brokerage accounts, real estate, collectibles, closely held stock, etc...) at any time during 2024?*(This is uncommon) Yes No Please list these other accounts and assets in the OTHER (403(B), 457, etc.) Plan and their value as of 12/31/2024. Any non-traditional assets (real estate, collectibles, closely-held stock, etc...) REQUIRE an annual appraisal, so also include the date of the last independent appraisal.*5) Was 2024 the first year of your OTHER (403(b), 457, etc.) retirement plan mentioned above?* Yes No Unsure Please list all accounts and assets in the OTHER (403(b), 457, etc.) Plan and their value as of 12/31/2024. Any non-traditional assets (real estate, collectibles, closely-held stock, etc...) REQUIRE an annual appraisal, so also include the date of the last independent appraisal.5.a-OTHER) Did you use OTHER (403(b), 457, etc.) Plan Assets to open any NEW accounts, or purchase other assets, that were NOT part of the retirement plan in 2023?*(We need to know if you have deposited plan assets somewhere else that we may not be aware of). Yes No Unsure Please list any new investments that have been added to the OTHER (403(b), 457, etc.) plan since 1/1/2024:*5) Was 2024 the first year of your DEFINED BENEFIT retirement plan mentioned above?* Yes No Unsure Please list all accounts and assets in the DEFINED BENEFIT Plan and their value as of 12/31/2024. Any non-traditional assets (real estate, collectibles, closely-held stock, etc...) REQUIRE an annual appraisal, so also include the date of the last independent appraisal.5.a-DB) Did you use DEFINED BENEFIT Plan Assets to open any NEW accounts, or purchase other assets, that were NOT part of the retirement plan in 2023?*(We need to know if you have deposited plan assets somewhere else that we may not be aware of). Yes No Unsure Please list any new investments that have been added to the DEFINED BENEFIT Plan since 1/1/2024:*6-DB) Regarding the DEFINED BENEFIT plan, other than that mentioned in questions 1 or 2 above, were there any OTHER transactions, deposits or withdrawals made to/from an account and/or investment in the plan in 2024?*(This question, in general, is trying to make sure that we are aware of any new accounts or investments that were opened in 2024, or if any plan transactions took place of which we are unaware). Yes No Unsure Please list the transactions in the DEFINED BENEFIT plan mentioned above that Fiduciary Advisors did NOT help process.6-PS) Regarding the PROFIT SHARING plan, other than that mentioned in question 1 or 2, were there any OTHER transactions, deposits or withdrawals made to/from an account/investment in the plan in 2024?*(This question, in general, is trying to make sure that we are aware of any new accounts or investments that were opened in 2024, or if any plan transactions took place of which we are unaware). Yes No Unsure Please list the transactions in the PROFIT SHARING plan mentioned above that Fiduciary Advisors did NOT help process.6-401K) Regarding the 401(K) plan, other than that mentioned in question 1 or 2 above, were there any OTHER transactions, deposits or withdrawals made to/from an account/investment in the plan in 2024?*(This question, in general, is trying to make sure that we are aware of any new accounts or investments that were opened in 2024, or if any plan transactions took place of which we are unaware). Yes No Unsure Please list the transactions in the 401(K) plan mentioned above that Fiduciary Advisors did NOT help process.6-OTHER) Regarding the OTHER (403(b), 457, etc.) plan, other than that mentioned in question 1 or 2 above, were there any OTHER transactions, deposits or withdrawals made to/from an account/investment in the plan in 2024?*(This question, in general, is trying to make sure that we are aware of any new accounts or investments that were opened in 2024 or if any plan transactions took place of which we are unaware) Yes No Unsure Please list the transactions in the OTHER (403(B), 457, etc.) plan mentioned above that Fiduciary Advisors did NOT help process.7) Check the box next to any/all of the following things that have changed during the last plan year:* The Name of the Company The Stock Ownership of the Company The Company's Address The Company's Entity Type (example: formed an LLC or Incorporated) The Board of Directors Trustees of the Retirement Plan The Main Contact Person for the Retirement Plan The Company's Accounting Firm The Retirement Plan's Financial Advisor No Changes to Any of the Above Items What is the New Full Legal Name of the Company?*Describe the Change of Ownership*What is the New Address?*Describe the New Entity Type.*List All Members of the Board of Directors*List All of the Retirement Plan Trustees.*Who is the New Main Contact Person for the Retirement Plan?* What is the New Contact Person's Email Address?* Enter Email Confirm Email What is the New Contact Person's Phone Number?*What is the New Accountant's Name?* What is the New Accountant's Email Address?* Enter Email Confirm Email What is the New Accountant's Phone Number?*What is the New Financial Advisors Name?* What is the New Financial Advisor's Email Address?* Enter Email Confirm Email What is the New Financial Advisor's Phone Number?*8) Other than the plan(s) mentioned above, has the company added or terminated any other qualified plan in this past year?* Yes No Describe what plan you terminated or new plan that you adopted in 2024:*9) Do any of the owners, stock holders, partners, or proprietor own ANY interest in other businesses?*(Do not include stock listed on a Stock Exchange.) Yes No Provide the name, type of entity, owners, percentage of ownership, whether entity has non-owner employees and describe any payments or services provided between the two companies (if any):*10) Is this company managed by another firm or does this company perform managerial services for another firm?* Yes No Provide the name, type of entity, owners, percentage of ownership, whether entity has non-owner employees and describe any payments or services provided between the two companies (if any):*11) Does the company lease employees to another firm or use leased employees?* Yes No Provide below the name(s) of entity(ies), and the relationship of services provided between the firms:*12) Does the company have any employees that are NOT owners?*NOTE: The definition of an owner is anyone that owns at least 5% of the company stock, OR is straight up and down the family tree of a 5% stock holder (i.e. spouse, children, and parents ARE considered owners). Yes No, all employees are "owners" as described above The trustee of the plan, pursuant to the Employees Retirement Income Security Act (ERISA) of 1974, is required to be bonded to protect against theft of the plan's assets. Please check one below:*NOTE: The bond amount should be the greater of the value of non-traditional assets held by the plan, or 10% of the plan's assets held in the retirement plan trust. I DO have an existing, active bond (Please provide FAL with a copy of the bond at your earliest convenience.) I DO NOT have a bond and need assistance in obtaining one. I DO NOT have a bond and will obtain one on my own. Please provide FAL with a copy of the bond once obtained. I have no idea what this is, please contact me. What is the name of the bonding company?*Please provide the amount of the bond, as this is included on the Form 5500 filed with the IRS.*In most instances, the amount of the bond must be for at least 10% of the plan's assets at the end of plan year, PLUS any additional contributions you will be deducting on your 2024 tax return.A reminder for those plans not on a recordkeeping platform: Please provide copies of the 2024 YEAR-END brokerage statement(s) for your plan(s) as soon as possible.Thank you for your time!